Background: Building on partnerships with Indigenous communities and with the support of the Northern Ontario School of Medicine, faculty created groundbreaking, authentic cultural immersion curriculum designed to foster culturally safe interpersonal skills and cultural understanding. However, structural barriers to the teaching of clinical communication skills for culturally safe care to Indigenous patients persisted. To address this challenge, faculty collaborated with Indigenous animators on the co-creation of a new teaching modality of Simulated Cultural Communication Scenarios. We evaluated student learning experience, the faculty teaching experience, the attainment of teaching goals, benefits, and areas for improvement for this approach. Methods: We piloted 9 Simulated Cultural Communication Scenarios with 64 medical students and 17 tutors. We collected quantitative and qualitative data regarding their experiences and perceptions of the new curriculum. The quantitative data was statistically summarized, and the qualitative data was coded and thematically analyzed. Results: The emergent themes indicate that co-created Simulated Cultural Communication Scenarios support the acquisition of culturally safe clinical skills because the modality fosters authentic, safe, context rich, and anti-oppressive patient dialogue with Indigenous animators. Recommendations for optimizing the sessions included ensuring tutors have a deep understanding of the significance of cultural safety in patient care. As the pedagogy is different from the familiar standardized clinical skills sessions, tutors and students benefit from education on the pedagogical approach. Conclusion: Simulated Cultural Communication Scenarios, co-created with cultural insiders and academic educators, represent an authentic education approach to teaching culturally safe clinical encounters. The findings contribute to our understanding of translating social accountability into the clinical setting.

Clinical learning activities involving Indigenous patient actors that specifically address the development of culturally safe care skills among medical students are important in order to improve health care for Indigenous people. In 2020, the COVID-19 pandemic led to strict physical distancing regulations and regional lockdowns that made the in-person delivery of Simulated Cultural Communication Scenarios (SCCS) with Indigenous patient actors impossible due to the disproportionate risk that public health emergencies pose for Indigenous communities. As the pandemic continued in 2021, we co-created a Virtual Visit approach to SCCS for the education of culturally safe care to pre-clerkship medical students. We report on student and tutor evaluation of these virtual sessions and contextualize our findings with our previous results delivering In-Person SCCSs. We found that Virtual Visit SCCS were highly effective in providing authentic exposure to and feedback from Indigenous patients. However, students rated their learning outcomes with Virtual Visit lower than the In-person approach to SCCS. We recommend formal training on interacting with patients in virtual care scenarios prior to Virtual Visit SCCS. We also found that exposure to SCCS with Indigenous animators has the potential to conjure up a diverse spectrum of sometimes unresolved negative feelings related to colonialism among students and tutors including discomfort, embarrassment, and anxiety. Our findings underscore the importance of resolving these sentiments within the safe environment of a classroom. To prepare Indigenous as well as non-Indigenous students and tutors adequately, it is important to acknowledge and critically deconstruct the embodiment of colonialism and Indigenous-settler relations when teaching physicians, as well as future physicians, preparedness for culturally safe care of Indigenous peoples.